{ "schemaVersion": 2, "eyebrow": "Gastroenterology", "title": "Irritable Bowel Syndrome", "summary": "Use a positive symptom-based diagnosis, screen selectively for inflammatory, celiac, infectious, and structural mimics, then match therapy to bowel pattern and dominant symptom while reassessing alarm features or treatment-resistant change.", "seoDescription": "Physician guide to diagnosing irritable bowel syndrome, excluding important mimics, and selecting symptom-directed treatment for IBS-C, IBS-D, and mixed IBS.", "clinicalQuestion": "How should clinicians diagnose IBS efficiently, exclude consequential mimics, and select treatment by stool subtype and dominant symptom?", "specialty": "Gastroenterology", "audience": "U.S. physicians and medical trainees", "tags": [ "irritable bowel syndrome", "IBS-D", "IBS-C", "Rome IV", "fecal calprotectin", "celiac serology", "low FODMAP diet", "rifaximin", "linaclotide" ], "keyTakeaways": [ "Make a positive IBS diagnosis using Rome IV symptoms and Bristol stool pattern; do not pursue exhaustive exclusion testing when alarm features are absent. [7][11][14]", "For suspected IBS-D, obtain tissue transglutaminase IgA with total IgA and use CRP plus fecal calprotectin or lactoferrin to evaluate for celiac disease and inflammatory bowel disease. [11][14]", "Treat the dominant symptom and subtype: soluble fiber, antispasmodics or peppermint oil for pain; laxative-based therapy and linaclotide for refractory IBS-C; loperamide for diarrhea, with rifaximin and selected 5-HT3-directed therapy for persistent IBS-D. [4][7][19]", "New onset after midlife, bleeding, unexplained iron-deficiency anemia, weight loss, nocturnal symptoms, or a relevant family history should redirect evaluation toward organic disease rather than empiric IBS escalation. [11][14][22]" ], "sections": [ { "id": "diagnostic-entry", "eyebrow": "Positive diagnosis", "heading": "When to diagnose IBS without extensive testing", "intro": "Confirm the symptom pattern, identify stool subtype, and screen immediately for features that alter the pathway.", "paragraphs": [ "Diagnose IBS clinically when recurrent abdominal pain occurs at least 1 day per week and is associated with defecation and/or a change in stool frequency or form. Classify subtype with the Bristol Stool Form Scale: IBS-D has more than 25% of bowel movements with loose or watery stools, while IBS-C, IBS-M, and IBS-U require subtype assignment from the prevailing stool pattern. Use the same scale longitudinally to document treatment response or subtype shift. [11][14][18]", "A symptom-based diagnosis is appropriate when the examination is unrevealing and alarm features are absent; in patients meeting Rome IV criteria for IBS-D without alarm features, symptom-based diagnosis has been reported as accurate in up to 98% of cases. Avoid broad food-allergy or food-sensitivity panels; reserve allergy evaluation for rapid, reproducible reactions that resolve with avoidance and are clinically compatible with food allergy. [11]", "At each initial or reassessment visit, ask specifically about rectal bleeding, unintentional weight loss, unexplained iron-deficiency anemia, nocturnal symptoms, new onset after age 45 to 50 years, acute unexplained symptom change, and a first-degree family history of colorectal cancer, inflammatory bowel disease, celiac disease, or significant gastrointestinal disease. These findings require evaluation for an organic disorder rather than labeling symptoms as uncomplicated IBS. [11][14][22]" ], "bullets": [ "Document abdominal pain frequency, its relationship to defecation, stool frequency, and Bristol form before initiating subtype-directed treatment. [11][14]", "Perform a focused abdominal examination and digital rectal examination when anorectal disease, bleeding, evacuation disorder, or another structural explanation is plausible. [10]", "Reopen the differential when a previously stable IBS phenotype develops persistent bleeding, anemia, weight loss, nocturnal symptoms, or a substantial bowel-habit change. [11][14]" ], "subsections": [], "table": { "caption": "Clinical features that determine whether to follow a limited IBS workup or pursue an organic-disease evaluation. [11][14][22]", "columns": [ "Clinical finding", "Interpretation", "Next action" ], "rows": [ [ "Rome IV pain pattern with altered stool form/frequency; no alarm features", "Supports a positive IBS diagnosis. [7][11][14]", "Classify stool subtype and obtain targeted testing when indicated by diarrhea-predominant symptoms or exposure history. [11][14]" ], [ "Unexplained iron-deficiency anemia, rectal bleeding, or recurrent bleeding", "Alarm pattern; IBS alone should not be assumed. [11][14]", "Evaluate for an organic gastrointestinal source, including structural and inflammatory disease. [11][14]" ], [ "Unintentional weight loss, nocturnal symptoms, or acute unexplained symptom change", "Raises concern for a non-IBS diagnosis. [14][22]", "Escalate diagnostic evaluation rather than proceeding through routine empiric IBS therapy. [14][22]" ], [ "New onset after age 45 to 50 years or first-degree family history of colorectal cancer, IBD, or celiac disease", "Higher-risk presentation requiring diagnostic reassessment. [11][14]", "Use history-directed investigation for colorectal, inflammatory, or celiac disease. [11][14]" ] ] } }, { "id": "targeted-workup", "eyebrow": "Rule out consequential mimics", "heading": "Targeted testing for diarrhea-predominant and atypical presentations", "intro": "Testing should answer a specific competing diagnosis, not serve as a routine exclusion panel.", "paragraphs": [ "For IBS-D or nonconstipated IBS without alarm features, obtain celiac serology with total serum IgA and tissue transglutaminase IgA. This combination identifies IgA deficiency that could make isolated tissue transglutaminase IgA testing unreliable and addresses celiac disease as a treatable mimic of chronic diarrhea and abdominal symptoms. [14]", "Use serum CRP together with fecal calprotectin or fecal lactoferrin when inflammatory bowel disease is a competing diagnosis in IBS-D. A fecal calprotectin value below 100 mcg/g, in a patient without alarm features and with normal routine blood testing, identified IBS with 98% certainty in one diagnostic investigation; an elevated marker should shift evaluation toward intestinal inflammation rather than functional treatment escalation. [11][13][14]", "Order a Giardia stool antigen only when exposure risk is present, including travel or immigration from endemic areas, untreated or inadequately treated water exposure, or daycare exposure. Do not use broad infectious testing as routine IBS workup in a stable, low-risk symptom pattern. [14]" ], "bullets": [ "Celiac testing: total IgA plus tissue transglutaminase IgA. [14]", "Inflammation testing in IBS-D: CRP plus fecal calprotectin or fecal lactoferrin. [11][14]", "Giardia testing: stool antigen when travel, endemic exposure, unsafe water, or daycare exposure is present. [14]" ], "subsections": [ { "heading": "Phenotypes that should not be managed as routine IBS", "paragraphs": [ "Watery Bristol type 6 to 7 stools occurring primarily during waking hours, urgency, bloating, incomplete evacuation, and mucus can occur in IBS-D, but these features do not override alarm signs or abnormal inflammatory testing. In a patient with weight loss, anemia, recurrent bleeding, later-life onset, or a relevant family history, pursue the alternative diagnosis suggested by the presentation before initiating repeated IBS-directed medication trials. [14]" ], "bullets": [] } ], "table": { "caption": "Focused diagnostic tests for common IBS-D mimics and their decision implications. [11][13][14]", "columns": [ "Competing diagnosis", "Test", "Interpretation and action" ], "rows": [ [ "Celiac disease", "Total serum IgA and tissue transglutaminase IgA. [14]", "Positive serology redirects evaluation to celiac disease rather than IBS-only management. [14]" ], [ "Inflammatory bowel disease", "CRP plus fecal calprotectin or fecal lactoferrin. [11][14]", "Normal results support an IBS pathway; elevated inflammatory markers warrant investigation for intestinal inflammation. [11][14]" ], [ "IBS versus IBD in low-risk presentation", "Fecal calprotectin <100 mcg/g with no alarm features and normal routine blood tests. [13]", "Reported to identify IBS with 98% certainty; interpret in the full clinical context. [13]" ], [ "Giardiasis", "Giardia stool antigen. [14]", "Test when exposure risk includes endemic travel or immigration, unsafe water, or daycare contact. [14]" ] ] } }, { "id": "foundational-management", "eyebrow": "Initial treatment", "heading": "Set a symptom-directed treatment plan", "intro": "Select one or two targets, define a response measure, and avoid simultaneous changes that obscure benefit.", "paragraphs": [ "Explain that IBS is diagnosed positively and that treatment targets symptom control rather than a proven disease-modifying therapy. Establish the dominant target—abdominal pain, diarrhea, constipation, bloating, or urgency—and track it with weekly symptom frequency and Bristol stool form. Symptoms and predominant stool pattern can change over time, so reassess the treatment target rather than assuming initial subtype is fixed. [7][11]", "For global symptoms or constipation-associated symptoms, use soluble fiber such as ispaghula at 6 to 30 g/day. Soluble fiber has moderate-quality evidence in unselected IBS populations; its use is preferable to a nonspecific recommendation to increase dietary fiber without identifying fiber type. [4]", "For abdominal pain, consider an antispasmodic or enteric peppermint oil as first-line pharmacologic options. Examples reported include hyoscine 20 mg three times daily and peppermint oil 200 mg three times daily. Antispasmodics can cause dry mouth, dizziness, and blurred vision; choose them cautiously when anticholinergic adverse effects are likely to limit adherence. [4][5]" ], "bullets": [ "Use a dietitian-supported low-FODMAP intervention when simpler dietary measures are insufficient or when diet is a prominent symptom trigger. [4][7][22]", "Use exercise as an adjunctive nonpharmacologic option; clinical reviews identify potential symptom benefit. [7]", "Do not use a positive response to diet, fiber, or antispasmodic therapy as proof that organic disease has been excluded when alarm features or abnormal tests are present. [11][14]" ], "subsections": [ { "heading": "Escalation for persistent pain", "paragraphs": [ "When first-line pain therapy is inadequate, central neuromodulation is a second-line option; tricyclic antidepressants are preferred in the cited management guidance. In practice, select this pathway when pain remains the principal disability after bowel-habit therapy and discuss adverse-effect tradeoffs before treatment. [4]" ], "bullets": [] } ], "table": { "caption": "Initial therapies selected by dominant IBS symptom. [4][5][7]", "columns": [ "Target", "Reasonable initial option", "Key selection issue" ], "rows": [ [ "Global symptoms or constipation-associated symptoms", "Soluble fiber, such as ispaghula 6-30 g/day. [4]", "Use soluble rather than an unspecified fiber strategy. [4]" ], [ "Abdominal pain", "Hyoscine 20 mg three times daily or peppermint oil 200 mg three times daily. [4]", "Antispasmodics carry anticholinergic-type adverse effects including dry mouth, dizziness, and blurred vision. [4]" ], [ "Diet-associated symptoms", "Low-FODMAP dietary intervention, preferably with dietitian involvement when initial measures fail. [4][7]", "Use a structured dietary trial rather than indiscriminate food-allergy testing. [11]" ], [ "Persistent pain after first-line measures", "Tricyclic antidepressant-based neuromodulation. [4]", "Reserve for insufficient response to first-line pain therapies. [4]" ] ] } }, { "id": "subtype-directed-therapy", "eyebrow": "Bowel-habit management", "heading": "Choose therapy by IBS-C or IBS-D phenotype", "intro": "Treat constipation and diarrhea directly while maintaining surveillance for a phenotype change that suggests another diagnosis.", "paragraphs": [ "For IBS-C, begin with laxative therapy for constipation. If constipation remains inadequately controlled after laxatives, offer a linaclotide trial; linaclotide is reported as a strong recommendation with high-quality evidence for IBS-C. Lubiprostone is also listed as a strongly recommended IBS-C option with moderate-quality evidence. [4][19]", "For IBS-D, loperamide is a first-line option for diarrhea, although evidence for efficacy is limited. For persistent nonconstipated IBS symptoms, rifaximin is listed as a strongly recommended treatment with moderate-quality evidence; eluxadoline and alosetron are listed as conditional options. Treatment selection should follow exclusion of celiac disease, inflammatory bowel disease, and exposure-related Giardia when those diagnoses remain plausible. [4][14][19]", "Alosetron and ramosetron are described as among the most effective options for diarrhea-predominant IBS in the cited management review, while the ACG-based summary characterizes alosetron as conditional with low-quality evidence. This difference supports reserving 5-HT3-directed therapy for selected refractory IBS-D after individualized risk-benefit assessment rather than positioning it as routine initial treatment. [4][19]" ], "bullets": [ "IBS-C not responding to laxatives: move to linaclotide rather than continuing ineffective laxative escalation indefinitely. [4]", "IBS-D with ongoing symptoms after first-line diarrhea control: consider rifaximin; evaluate eluxadoline or alosetron selectively. [19]", "IBS-M: reclassify the current predominant symptom at each treatment decision and avoid a fixed long-term label when stool pattern shifts. [7][11]" ], "subsections": [], "table": { "caption": "Subtype-directed medication options supported in cited IBS management literature. [4][19]", "columns": [ "Subtype and problem", "Treatment sequence", "Evidence or practical limitation" ], "rows": [ [ "IBS-C with constipation", "Laxative trial first. [4]", "Laxatives are used first line for constipation. [4]" ], [ "IBS-C refractory to laxatives", "Trial linaclotide. [4]", "Linaclotide is listed as a strong recommendation with high-quality evidence for IBS-C. [19]" ], [ "IBS-C requiring prescription alternative", "Lubiprostone. [19]", "Listed as a strong recommendation with moderate-quality evidence. [19]" ], [ "IBS-D with diarrhea", "Loperamide first line. [4]", "Evidence for efficacy is described as limited. [4]" ], [ "Persistent IBS-D or nonconstipated IBS symptoms", "Rifaximin. [19]", "Listed as a strong recommendation with moderate-quality evidence. [19]" ], [ "Selected refractory IBS-D", "Eluxadoline or alosetron. [19]", "Both are listed as conditional options; alosetron is characterized as low-quality evidence in the ACG-based summary. [19]" ] ] } }, { "id": "follow-up-escalation", "eyebrow": "Monitoring", "heading": "Reassess response and identify failed-IBS pathways", "intro": "Follow treatment response by prespecified symptom targets and escalate investigation when the phenotype no longer fits.", "paragraphs": [ "At follow-up, compare abdominal pain frequency, stool frequency, Bristol stool form, urgency, and functional impairment with baseline. Continue an intervention only when the measured target improves; when it does not, determine whether the failure reflects incorrect subtype targeting, inadequate adherence to a dietary or fiber trial, adverse effects, or an alternative diagnosis requiring renewed testing. [7][11]", "Escalate beyond routine IBS management when targeted testing is abnormal, an alarm feature emerges, or symptoms become newly atypical. A low fecal calprotectin result can support an IBS pathway in a low-risk presentation, but it does not supersede bleeding, anemia, weight loss, later-life onset, or a strong family history. [11][13][14]", "For persistent pain despite dietary, bowel-habit, and first-line analgesic approaches, use a neuromodulator pathway rather than repeatedly changing antidiarrheals or laxatives when pain is the main remaining symptom. For persistent IBS-C after laxatives, use linaclotide; for persistent IBS-D, consider rifaximin or a selected subtype-specific agent after revisiting celiac, inflammatory, and infectious alternatives. [4][14][19]" ], "bullets": [ "Monitor each trial against a named target: pain, stool form, stool frequency, urgency, or constipation. [7][11]", "Reassess medication adverse effects, particularly dry mouth, dizziness, and blurred vision with antispasmodics. [4]", "Repeat diagnostic assessment when alarm features arise, even in a patient with an established prior IBS diagnosis. [11][14]" ], "subsections": [], "table": { "caption": "Follow-up triggers that change management. [4][11][13][14][19]", "columns": [ "Follow-up finding", "Interpretation", "Next step" ], "rows": [ [ "Improved target symptom and stable absence of alarm features", "Current subtype-directed strategy is effective. [7][11]", "Continue the effective intervention and monitor stool pattern because subtype may change over time. [7]" ], [ "Persistent pain despite first-line measures", "Pain-predominant IBS may need a neuromodulator strategy. [4]", "Consider tricyclic antidepressant-based central neuromodulation. [4]" ], [ "IBS-C persists despite laxatives", "Initial constipation therapy has failed. [4]", "Offer linaclotide. [4]" ], [ "IBS-D persists despite first-line control", "Consider escalation after revisiting mimics. [14][19]", "Consider rifaximin; select eluxadoline or alosetron when appropriate. [19]" ], [ "New bleeding, anemia, weight loss, nocturnal symptoms, or abnormal inflammatory testing", "Presentation no longer supports routine uncomplicated IBS management. [11][14]", "Pursue evaluation for organic gastrointestinal disease. [11][14]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Yield of Diagnostic Tests for Celiac Disease in Individuals ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108430", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "Ethosuximide and Irritable Bowel Syndrome–Related ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843540", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Acupuncture for the Treatment of Diarrhea-Predominant ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799968", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 4, "title": "Best management of irritable bowel syndrome", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/flgastro/12/4/303.full.pdf", "authors": "fg.bmj.com", "host": "fg.bmj.com" }, { "number": 5, "title": "Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis | The BMJ", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/337/bmj.a2313.full", "authors": "www.bmj.com", "host": "www.bmj.com" }, { "number": 6, "title": "Management of the multiple symptoms of irritable bowel syndrome", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30116-9/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 7, "title": "Irritable bowel syndrome", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/345/bmj.e5836", "authors": "www.bmj.com", "host": "www.bmj.com" }, { "number": 8, "title": "CLINICAL REVIEW", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/bmj/345/bmj.e5836.full.pdf", "authors": "www.bmj.com", "host": "www.bmj.com" }, { "number": 9, "title": "British Society of Gastroenterology guidelines on the ...", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/gutjnl/early/2021/05/24/gutjnl-2021-324598.full.pdf", "authors": "gut.bmj.com", "host": "gut.bmj.com" }, { "number": 10, "title": "Irritable bowel syndrome | Nature Reviews Disease Primers", "detail": "www.nature.com", "url": "https://www.nature.com/articles/nrdp201614", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 11, "title": "Diagnosis and treatment of irritable bowel... : Journal of the American Association of Nurse Practitioners", "detail": "journals.lww.com", "url": "https://journals.lww.com/jaanp/_layouts/15/oaks.journals/downloadpdf.aspx?an=01741002-202603000-00008", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 12, "title": "Knowledge Does Not Translate Into Diagnostic Restraint ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/nmo.70335", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 13, "title": "Diagnosis and investigation of irritable bowel syndrome", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/apt.16597", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 14, "title": "Differential Diagnosis of Chronic Diarrhea : Journal of Clinical Gastroenterology", "detail": "journals.lww.com", "url": "https://journals.lww.com/jcge/_layouts/15/oaks.journals/downloadpdf.aspx?an=00004836-202308000-00004", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Canadian Association of Gastroenterology Clinical Practice ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcag/article/2/1/6/5290372", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 16, "title": "Algorithms or biomarkers in patients with lower DGBI?", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/nmo.14856", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 17, "title": "defined irritable bowel syndrome in the United Kingdom", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/apt.16939", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 18, "title": "Irritable bowel syndrome and diet | Gastroenterology Report", "detail": "academic.oup.com", "url": "https://academic.oup.com/gastro/article/5/1/11/2931986", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 19, "title": "S688 Irritable Bowel Syndrome Therapy and Cost in Uninsured : Official journal of the American College of Gastroenterology | ACG", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2023/10001/s688_irritable_bowel_syndrome_therapy_and_cost_in.1044.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 20, "title": "Nonallergic Diseases Associated With Foods", "detail": "www.jaci-inpractice.org", "url": "https://www.jaci-inpractice.org/article/S2213-2198(23)01058-9/abstract", "authors": "www.jaci-inpractice.org", "host": "www.jaci-inpractice.org" }, { "number": 21, "title": "Clinical study protocol", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/39/NCT05392439/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov" }, { "number": 22, "title": "Evaluate and compare the clinical efficacy of the Mediterranean ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/19/NCT05807919/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov" }, { "number": 23, "title": "Study Details | NCT06420843 | Microbiota, Metabolome and Nutrition: an 'Artificially Intelligent' Way to Personalized Nutrition | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT06420843", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov" }, { "number": 24, "title": "Effects of Rifaximin on Visceral Hypersensitivity in Irritable ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/66/NCT03462966/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Yield of Diagnostic Tests for Celiac Disease in Individuals ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108430", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by AC Ford · 2009 · Cited by 378 — comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome.", "score": 0.17968917 }, { "number": 2, "title": "Ethosuximide and Irritable Bowel Syndrome–Related ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843540", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by N Kerckhove · 2026 — Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by recurrent abdominal pain and altered bowel habits.1", "score": 0.17507249 }, { "number": 3, "title": "Acupuncture for the Treatment of Diarrhea-Predominant ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799968", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by LY Qi · 2022 · Cited by 79 — Acupuncture is a promising therapy for irritable bowel syndrome (IBS), but the use of subjective scales as an assessment is accompanied by high", "score": 0.08261607 }, { "number": 4, "title": "Best management of irritable bowel syndrome", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/flgastro/12/4/303.full.pdf", "authors": "fg.bmj.com", "host": "fg.bmj.com", "snippet": "a low FODMAP diet is appropriate. First-­ line drug therapy includes anti-spasmodics and peppermint oil for the treatment of abdominal pain. Loperamide and laxatives can be tried for the treatment of diarrhoea or constipation, respec-tively, although evidence for their efficacy is limited. [...] dis", "score": 0.72184175 }, { "number": 5, "title": "Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis | The BMJ", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/337/bmj.a2313.full", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "Title: Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis | The BMJ\n3. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. # Effect of", "score": 0.7216064 }, { "number": 6, "title": "Management of the multiple symptoms of irritable bowel syndrome", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30116-9/abstract", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "Management of the multiple symptoms of irritable bowel syndrome - The Lancet Gastroenterology & Hepatology. Management of the multiple symptoms of irritable bowel syndrome. Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. **Why do subjects with irritabl", "score": 0.6055431 }, { "number": 7, "title": "Irritable bowel syndrome", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/345/bmj.e5836", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "#### Summary points\n\n Irritable bowel syndrome (IBS) affects up to one in five people at some point in their lives\n\n The condition is commoner in younger people and women, and is not associated with increased mortality\n\n A positive diagnosis of IBS should be reached using symptom based clinica", "score": 0.5815176 }, { "number": 8, "title": "CLINICAL REVIEW", "detail": "www.bmj.com", "url": "https://www.bmj.com/content/bmj/345/bmj.e5836.full.pdf", "authors": "www.bmj.com", "host": "www.bmj.com", "snippet": "Effect of fibre, antispasmodics, and peppermint oil in irritable bowel syndrome: systematic review and meta-analysis.", "score": 0.57723385 }, { "number": 9, "title": "British Society of Gastroenterology guidelines on the ...", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/gutjnl/early/2021/05/24/gutjnl-2021-324598.full.pdf", "authors": "gut.bmj.com", "host": "gut.bmj.com", "snippet": "by DH Vasant · 2021 · Cited by 751 — Peppermint oil in irritable bowel syndrome. ... β-galactooligosaccharide in conjunction with low FODMAP diet improves irritable bowel syndrome", "score": 0.56575525 }, { "number": 10, "title": "Irritable bowel syndrome | Nature Reviews Disease Primers", "detail": "www.nature.com", "url": "https://www.nature.com/articles/nrdp201614", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Article \n CAS \n PubMed \n PubMed Central \n Google Scholar\n140. Jones, M. P. et al. A biomarker panel and psychological morbidity differentiates the irritable bowel syndrome from health and provides novel pathophysiological leads. Aliment. Pharmacol. Ther. 39, 426–437 (2014).\n\n Art", "score": 0.32549962 }, { "number": 11, "title": "Diagnosis and treatment of irritable bowel... : Journal of the American Association of Nurse Practitioners", "detail": "journals.lww.com", "url": "https://journals.lww.com/jaanp/_layouts/15/oaks.journals/downloadpdf.aspx?an=01741002-202603000-00008", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "As noted in the introduction, Rome IV criteria, lack of alarm symptoms, and limited diagnostic testing should be used to formalize a confident diagnosis of IBS and treatment approach (Lacy et al., 2016). Alarm features to be considered include iron-deficiency anemia of unknown etiology; unintentiona", "score": 0.7140107 }, { "number": 12, "title": "Knowledge Does Not Translate Into Diagnostic Restraint ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/nmo.70335", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by M Linares · 2026 · Cited by 3 — Alarm features were selected a priori based on Rome IV bowel disorder criteria and contemporary IBS diagnostic guidance, and included", "score": 0.6907474 }, { "number": 13, "title": "Diagnosis and investigation of irritable bowel syndrome", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/apt.16597", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Dec 19, 2021 — A faecal calprotectin cut off <100 mcg/g identified IBS with 98% certainty in patients with no alarm features, normal routine bloods and", "score": 0.6383174 }, { "number": 14, "title": "Differential Diagnosis of Chronic Diarrhea : Journal of Clinical Gastroenterology", "detail": "journals.lww.com", "url": "https://journals.lww.com/jcge/_layouts/15/oaks.journals/downloadpdf.aspx?an=00004836-202308000-00004", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "of IBS-D, but commonly identified at presentation, include abdominal bloating and/or distension, fecal urgency, sensations of incomplete evacuation, and the passage of mucus in stools.7 Stools are characteristically watery (Bristol Stool Form Scale 6-7, Fig. 1) and passed during waking hours. Stress", "score": 0.48191768 }, { "number": 15, "title": "Canadian Association of Gastroenterology Clinical Practice ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcag/article/2/1/6/5290372", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by P Moayyedi · 2019 · Cited by 289 — Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C- ...Read more", "score": 0.37113717 }, { "number": 16, "title": "Algorithms or biomarkers in patients with lower DGBI?", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/nmo.14856", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Current algorithms proposed for the management of irritable bowel syndrome focus on the exclusion of alarm features, and sequential therapeutic trials with", "score": 0.36520815 }, { "number": 17, "title": "defined irritable bowel syndrome in the United Kingdom", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/apt.16939", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "We collected demographic, gastrointestinal and psychological symptoms, quality of life and healthcare usage data from adults with Rome IV or", "score": 0.2819544 }, { "number": 18, "title": "Irritable bowel syndrome and diet | Gastroenterology Report", "detail": "academic.oup.com", "url": "https://academic.oup.com/gastro/article/5/1/11/2931986", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by P Portincasa · 2017 · Cited by 94 — The recent ROME IV Consensus requires abdominal pain to be recurrent and associated with defecation or change in bowel habits (Table 1) [9]. IBS subtypes ...Read more", "score": 0.26948613 }, { "number": 19, "title": "S688 Irritable Bowel Syndrome Therapy and Cost in Uninsured : Official journal of the American College of Gastroenterology | ACG", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2023/10001/s688_irritable_bowel_syndrome_therapy_and_cost_in.1044.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: S688 Irritable Bowel Syndrome Therapy and Cost in Uninsured : Official journal of the American College of Gastroenterology | ACG\nIrritable Bowel Syndrome (IBS) is one of the most common gastrointestinal illnesses leading to high morbidity and decreased quality of life despite available therap", "score": 0.60694176 }, { "number": 20, "title": "Nonallergic Diseases Associated With Foods", "detail": "www.jaci-inpractice.org", "url": "https://www.jaci-inpractice.org/article/S2213-2198(23)01058-9/abstract", "authors": "www.jaci-inpractice.org", "host": "www.jaci-inpractice.org", "snippet": "by PK Patel · 2024 · Cited by 5 — Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. ACG clinical guideline: management", "score": 0.5792344 }, { "number": 21, "title": "Clinical study protocol", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/39/NCT05392439/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "the Rome IV diagnostic criteria (26) for IBS-C. Exclusion criteria: 1) had a history of previous abdominal surgery (other than appendectomy), 2) suffering from carcinoma, 3) had any organic diseases causing constipation or neurologic diseases such as multiple sclerosis, rachischisis, Parkinson’s dis", "score": 0.57006866 }, { "number": 22, "title": "Evaluate and compare the clinical efficacy of the Mediterranean ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/19/NCT05807919/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "Published online February 18, 2016:S0016-5085(16)00222-5. doi:10.1053/j.gastro.2016.02.031 22. Goodoory VC, Ng CE, Black CJ & Ford AC. Willingness to accept risk with medication in return for cure of symptoms among patients with Rome IV irritable bowel syndrome. Aliment Pharmacol Ther. 2022;55:1311–", "score": 0.5401241 }, { "number": 23, "title": "Study Details | NCT06420843 | Microbiota, Metabolome and Nutrition: an 'Artificially Intelligent' Way to Personalized Nutrition | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT06420843", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov", "snippet": "Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954.:949-58. doi: 10.1001/jama.2015.0954. (opens in a new tab)\")(\n Anastasi JK, Capili B, Chang M. Managing irritable bowel syndrome. Am J Nurs. 2013 Jul;113(7):42-", "score": 0.37710527 }, { "number": 24, "title": "Effects of Rifaximin on Visceral Hypersensitivity in Irritable ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/66/NCT03462966/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "irritable bowel syndrome. Am J Gastroenterol 2009;104 Suppl 1:S1-35. 6. Dalrymple J, Bullock I. Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. Bmj 2008;336:556-8. 7. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial over", "score": 0.36724812 } ], "publishedAt": "2026-08-24T17:28:16.168507+00:00", "updatedAt": "2026-08-24T17:28:16.168507+00:00", "readingMinutes": 6, "slug": "irritable-bowel-syndrome" }